Executives at post-acute-care facilities, behavioral health institutions and home care providers are trying to figure out how they best fit within the accountable care organization model.
ACOs created under the Affordable Care Act can only be helmed by hospitals or primary care physician groups, leaving auxiliary services in a waiting pattern. Accountable care organizations are groups of providers working together to streamline care coordination for populations of patients while making care better and more affordable.
Bergen Regional Medical Center's participation in the ACO dialogue is "a book yet to be written," said CEO Joseph Orlando.
Bergen Regional, in addition to
being an acute-care provider, provides inpatient and outpatient behavioral health services, as well as long-term care options.
"We're a very big safety net provider, but we're focused on behavioral health. … Our reach and our influence in the psychiatric world is much greater," said Orlando. "You can't be a medical home without (behavioral health), and we have yet to write how we fit in that."
He said there is often a psychological link to physical ailments, and in order for there to be a long-term change in the way care is delivered, patients need to be looked at more holistically, with more emphasis on how mental health may play a role in physical health.
Dr. Steven Landers, CEO of the VNA Group, said the VNA has been in discussions to join an ACO in the Central Jersey market, as well as in some cases been approached about providing care coordination services for an ACO group.
If ACOs expect to be successful, they will have to address certain issues, such as end-of-life care, a well-documented challenge for New Jersey and every state, and a specialty of post-acute-care providers. Most costs and bad outcomes are concentrated in a small group of people with multiple morbidities or chronic diseases, and home care providers are experts with this population.
"I think those discussions are being had, and I think depending on the specific ACO and the specific target population, the level of those conversations and the arrangement is different," Landers said. "But in general, I think it is being recognized one of the key challenges is how do you keep people healthy at home and in the community."
Post-acute-care facilities are waiting for cues from acute-care hospitals, according to Darlene Hanley, president and CEO of St. Lawrence Rehabilitation Center in Lawrenceville. Hanley told an audience of Mercer County business people at a recent health care symposium that she was waiting for the county's acute-care hospitals to make formal plans before she could engage in decisions about accountable care.
"What their plans are for joining an ACO or developing an ACO, I'm not privy to that information," Hanley said.
Hanley did not have a problem with the way the law is structured, which prohibits a post-acute-care facility from creating its own ACO. She said the government's priority of putting that responsibility with acute-care facilities makes sense.
"That is where the provision of care given is the most acute, that's where funding is being placed in order to develop these connections between the institutions and the physician providers," Hanley said. "My goal is that St. Lawrence will be positioned as far as being a good provider of services, and efficient provider, that they will want to partner with us … that could be the loose referral relationship we have now, (or) it may be a more contractual relationship."
Hanley said she's confident that acute-care providers in the area are aware of St. Lawrence's dedication to the same priorities – efficient care in appropriate settings with reduced readmissions – and that her facility will have a seat at the ACO discussion table.
"In the long run, the government is going to have to look at the post-acute-care area and dedicate some resources there as well," Hanley said.
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